Risk Factor Burden in Middle Age and Lifetime Risks for Cardiovascular and Non-Cardiovascular Death (Chicago Heart Association Detection Project in Industry)

Abstract

Data are sparse regarding the association of risk factor burden in middle age with lifetime risks for cardiovascular disease (CVD) and non-CVD death. We straitified participants of the Chicago Heart Association Detection Project in Industry aged 40 to 59 years in 1967-1973 into 5 groups based on risk factor burden: favorable risk factor profile (untreated blood pressure ≤120/≤80 mm Hg, total cholesterol <200 mg/dL, non-smoking, and body mass index [BMI] <25 kg/m 2 ); 0 elevated but ≥1 unfavorable; or any 1, any 2, or ≥3 elevated (systolic ≥140 or diastolic ≥90 mm Hg, or treated hypertension; total cholesterol ≥240 mg/dL; current smoking; or BMI ≥30 kg/m 2 ). We estimated remaining lifetime risks for CVD and non-CVD death through age 85 years. We followed 8033 men and 6493 women for 409,987 person-years; 2582 died of CVD and 3955 died of non-CVD causes. Greater risk factor burden was associated with higher incidence of both CVD and non-CVD death. Compared with participants with ≥3 risk factors, those with favorable profiles had substantially lower lifetime risks for CVD death (20.5% vs. 35.2% in men, 6.7% vs. 31.9% in women) and markedly longer median Kaplan-Meier survival (>35 vs. 26 years in men, >35 vs. 28 years in women). In conclusion, having favorable risk factors in middle age is associated with lower lifetime risk for CVD death and markedly longer survival. These results should encourage efforts aimed at preventing development of risk factors in younger individuals to decrease CVD mortality and promote longevity.

Hematocrit and the risk of coronary heart disease mortality in the TAMRISK study, a 28-year follow-up

“…The risk of thrombosis may be enhanced by borderline polycythemia, as manifested by an HCT value of ≥50%. Recent data emphasizes the association of risk factor burden in middle age with lifetime risks for cardiovascular disease death (Lloyd-Jones et al, 2007). Having favorable risk factors in middle age is associated with a lower lifetime risk for CVD death and markedly longer survival.…”

Lifestyle behaviour and lifetime incidence of heart diseases

“…More recently, some studies that started in the past century did reach extremely long follow-up observation allowing the production of estimates of the relations of entry characteristics with health and disease projected along several decades [12][13][14][15][16][17][18]. Observations of this type are sometimes defined as lifetime estimates although studies with complete extinction of the original cohorts are rare [19].…”

Natural history of coronary heart disease and heart disease of uncertain etiology: Findings from a 50-year population study

“…Extremely long-term duration follow-up of population studies leading to extinction of the initially enrolled cohorts is quite rare in the literature [1][2][3][4][5][6][7][8] and the natural history of lifetime incident heart diseases has been mostly related to analysis of mortality and age at death as a function of various parameters measured at base-line [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Indeed, incident non-fatal events are quite difficult to measure and evaluate and very long-term longitudinal investigations require several generations of researchers involved and continuous commitment.…”